The rule for when to go to hospital for a dental problem is short. An emergency department is the right place when the problem threatens your airway, your eye, or your ability to swallow or breathe. A dentist is the right place when the problem is the tooth itself. Australians end up in hospital for dental conditions far more often than they should. The Australian Institute of Health and Welfare counted about 88,600 hospitalisations for dental conditions that could potentially have been prevented with earlier treatment in a single year. Almost all of those started as something a dentist could have handled.
Key takeaways
- Call 000 or go straight to an emergency department for difficulty breathing, difficulty swallowing, swelling under the jaw or in the floor of the mouth, or swelling closing the eye.
- An emergency department is for airway, bleeding and trauma. It is not set up for definitive dental treatment.
- Australian emergency departments generally do not perform root canal treatment, and most will not do a non-urgent extraction.
- Dental conditions make up about 24 percent of acute potentially preventable hospitalisations, second only to urinary tract infections at 25 percent.
- Ludwig's angina is odontogenic in about 90 percent of cases. Mortality is now around 8 percent with airway management, intravenous antibiotics and drainage, down from more than 50 percent before antibiotics.
- Ordinary toothache, a lost filling or a crown that has come off are dentist problems, not hospital problems.
Red flags: go to hospital now
If any of the following apply, call 000 or go straight to a hospital emergency department. Do not ring a dentist first and do not wait until morning.
- Any difficulty breathing, noisy breathing, or a feeling that the throat is closing.
- Difficulty or pain on swallowing, drooling because swallowing hurts, or a change in your voice.
- Swelling under the jaw, in the floor of the mouth, or a tongue that feels pushed upwards.
- Facial swelling that is closing the eye, or any change in vision.
- Being unable to open your mouth more than a centimetre or two when you previously could.
- Fever, shaking chills or feeling generally very unwell alongside facial swelling.
- Bleeding you cannot control with 20 minutes of firm continuous pressure.
- A suspected broken jaw, a knock that caused loss of consciousness, or a facial injury with numbness.
The reason this list is not softened is Ludwig's angina, a rapidly spreading infection of the floor of the mouth that is odontogenic in about 90 percent of cases, meaning it started at a tooth. Before antibiotics its mortality exceeded 50 percent. It is now approximately 8 percent with airway management, intravenous antibiotics and surgical drainage. That improvement depends entirely on people arriving in time. The risk of a bad outcome is higher if you are over 65, diabetic, immunosuppressed or a heavy drinker.
Where to go, and how fast
| What you have | Where to go | How fast |
|---|---|---|
| Ordinary toothache, no swelling | Dentist | Within a day or two, sooner if it is keeping you awake |
| Swelling confined to the gum around one tooth | Dentist | Same day or next day |
| Facial swelling of the cheek or jaw | Dentist same day, or emergency department if no dentist is available | Same day, without fail |
| Swelling closing the eye | Emergency department | Immediately |
| Difficulty swallowing or breathing | Call 000 or emergency department | Immediately, do not drive yourself |
| Bleeding after an extraction that will not stop | Dentist if reachable, otherwise emergency department | After 20 minutes of firm pressure has failed |
| Knocked out adult tooth | Dentist, or emergency department after hours | Within 30 to 60 minutes, store it in milk on the way |
| Broken jaw or major facial injury | Emergency department | Immediately |
| Lost filling or crown, no pain | Dentist | Within a week, not an emergency |
What an emergency department can and cannot do
This is the part people are not told, and it causes a lot of wasted nights in waiting rooms. Australian emergency departments generally cannot provide definitive dental care. They do not perform root canal treatment. Most will not carry out a non-urgent extraction. What they can do is assess whether an infection is threatening the airway, give intravenous antibiotics and fluids, provide pain relief, control bleeding, manage facial trauma, arrange imaging, and admit you or refer you to a maxillofacial service if that is needed.
Emergency doctors are also, understandably, not dentists. A survey of Australasian emergency physicians found limited knowledge and confidence in managing dental emergencies, which is exactly why the NSW Agency for Clinical Innovation publishes a dental emergencies clinical tool for emergency department staff. The system knows this is a gap.
So if you attend an emergency department with a straightforward toothache, the likely result is a prescription, some analgesia and advice to see a dentist. The tooth is still there and still hurting the next day. That is not a failure of the hospital. It is the wrong door.
Why so many people end up there anyway
Timing explains most of it. In an audit at the Royal Hobart Hospital, 454 presentations in one year were primarily dental, which was 0.91 percent of all emergency department presentations, and 68 percent of them arrived after hours when dentists were closed. Teeth do not read the clock. Pain that has been building all week peaks at 11pm.
Cost and access explain much of the rest. Around 13.2 billion dollars was spent on dental services in Australia in a single year, with 8.0 billion of that, about 61 percent, paid directly by patients, averaging 296 dollars per person over 12 months. Those are national figures published for Australia as a whole. They are not the fees of any particular practice, including this one. But they explain why some people wait, and waiting is exactly what turns a filling into a hospital admission.
The scale of that is worth sitting with. Dental conditions account for about 24 percent of acute potentially preventable hospitalisations, second only to urinary tract infections at 25 percent. The age-standardised rate of potentially preventable dental hospitalisations has sat between 2.8 and 3.4 per 1,000 population across the last decade of reporting, and in the most recent year reported it was 5.6 per 1,000 for Indigenous Australians compared with 3.3 for other Australians. Decay is the leading cause, followed by embedded and impacted teeth, and the highest rate of all is in children aged 5 to 9.
The problems that are genuinely a dentist's job
Most dental emergencies belong in a dental chair, and being seen quickly usually costs less and hurts less than waiting. A toothache with no swelling, a cracked tooth, a lost filling, a crown that has come off, a broken denture, a wire poking the cheek, sensitivity that has become constant. All of those need a dentist and none of them need a hospital.
A localised abscess sits in between. If the swelling is confined to the gum next to one tooth and you are otherwise well, that is a same day dental appointment. If the swelling is spreading into the face, closing the eye, or you feel unwell with it, the picture has changed. Our article on the signs and treatment of a tooth abscess goes through how to tell the difference, and our broader dental emergency guide covers what counts as urgent.
If you are unsure who to ring after hours, our article on what to do when you need an emergency dentist sets out the practical steps.
Trauma, knocked out teeth and broken jaws
Facial trauma is the clearest case for hospital. If the jaw feels out of line, the teeth no longer meet the way they used to, there is numbness in the lip or chin, or there was a loss of consciousness, go to an emergency department. Our article on first aid for a broken jaw and facial trauma covers what to do on the way.
A knocked out adult tooth is the one time a dentist beats a hospital on speed. Replant it immediately if you can, holding it by the crown and not the root. If you cannot, put it in milk and get to a dentist. If it is after hours and no dentist is available, an emergency department is still worth attending, because the tooth needs splinting. The full protocol is in our article on first aid for a knocked out tooth. A knocked out baby tooth is never replanted.
Sedation and general anaesthetic
People sometimes assume that going to hospital means the tooth will be taken out under a general anaesthetic that night. That is rarely how it works. General anaesthetic for dental treatment is planned, done in a hospital or day surgery setting with an anaesthetist, and has its own waiting list. Lumi Dental does not provide general anaesthetic. For anxious patients who need more than local anaesthetic, intravenous sedation is a different option and you can read about how it works on our page about IV sedation dentistry in Melrose Park.
What to do while you wait
- Take the painkillers you normally tolerate, at the labelled dose, and note the time you took them.
- Keep your head propped up. Lying flat makes throbbing and swelling worse.
- Use a cold pack on the outside of the face for swelling from an injury. Do not apply heat to a swelling you think is infected.
- Do not put aspirin against the gum. It burns the tissue and does nothing for the tooth.
- Take a photo of the swelling. If it visibly spreads over a few hours, that is information the hospital wants.
- Write down your medicines and allergies before you leave the house.
Common questions
Will the hospital pull my tooth out?
Usually not. Australian emergency departments are generally not resourced for non-urgent extractions and do not provide root canal treatment. They will manage pain, infection, bleeding and airway risk, then refer you on. If the infection is severe you may be admitted for intravenous antibiotics and surgical drainage, which is a different matter to a routine extraction.
Should I go to hospital for a really bad toothache?
If it is pain alone, with no swelling, no fever and no trouble swallowing, a dentist is the right place and a hospital visit will most likely end in a prescription and a referral. If the pain comes with facial swelling, fever, or any difficulty swallowing or breathing, go to hospital immediately. Pain severity alone is not the deciding factor. Swelling and airway symptoms are.
How do I know if a dental infection is spreading?
Watch the boundaries. Swelling that stays next to one tooth is localised. Swelling that moves into the cheek, under the jaw, up towards the eye or down the neck is spreading. Add fever, trouble opening your mouth, painful swallowing or feeling generally unwell and it is an emergency department problem, not a wait and see problem.
Can I go to hospital for a knocked out tooth?
Yes, particularly after hours, and it is better than doing nothing. But speed matters more than the venue. Replant the tooth straight away if you can manage it, or store it in milk, and get to whoever can see you fastest. Dry time outside the mouth is what decides whether the tooth survives.
What happens if I ignore a dental abscess?
Sometimes it drains and the pain eases, which is misleading, because the infection is still there. Sometimes it spreads into the tissue spaces of the face and neck, which is how people end up admitted with an airway at risk. The infection does not resolve without treatment of the tooth itself, so an abscess that has stopped hurting still needs an appointment.
Most hospital visits for dental problems start as something small that waited too long. If a tooth has been niggling, get it looked at while it is still a small job. The team at Lumi Dental in Melrose Park is open Monday to Saturday, with Sunday by appointment, and keeps time aside for people in pain. New patients can see what is currently available on our current deals page.
This article is general information only. It is not personal dental or medical advice, and it cannot account for your own history, medicines or examination findings. Please see a dentist or your doctor about your own situation.
